Effects of Secondary Bone Grafting Period on Growth and Development in Dentofacial Complex in Patients with Complete Unilateral Cleft Lip and Palate
Objectives: The purpose of this study was to investigate the effects of the timing of secondary bone grafting on the growth and development of dentofacial complex in patients with complete unilateral cleft lip and palate (UCLP). Design: Retrospective lateral cephalometric study. Interventions: Thirt...
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| Published in | Journal of Japanese Cleft Palate Association Vol. 32; no. 3; pp. 283 - 298 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Cleft Palate Association
30.10.2007
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0386-5185 2186-5701 |
| DOI | 10.11224/cleftpalate1976.32.3_283 |
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| Abstract | Objectives: The purpose of this study was to investigate the effects of the timing of secondary bone grafting on the growth and development of dentofacial complex in patients with complete unilateral cleft lip and palate (UCLP). Design: Retrospective lateral cephalometric study. Interventions: Thirty patients received similar primary surgical procedures by the same surgeon and the similar first phase orthodontic treatment. These patients were divided into two groups according to their age at secondary bone grafting: 23 patients at a mean age of 9.6 years (early group) and 7 at a mean age of 12.2 years (late group). Methods: Lateral cephalometric radiographs of all subjects were obtained at two different times: at the age of 7 or 8 years (prior to bone grafting) and at the age of 15 or 16 years (more than one year after bone grafting). Twenty-eight measurement items on the sagittal and vertical growth of viscerocranium were compared between the early and late groups by the unpaired t-test. Results and discussion: Vertical maxillary growth was inhibited significantly in the early group in comparison with the late group; however, there was no significant difference in sagittal maxillary growth between the two groups. This suggests that sagittal anterior maxillary growth is almost completed before the age of 10 years, but the alveolar process is still growing vertically after the age of 10 years. |
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| AbstractList | Objectives: The purpose of this study was to investigate the effects of the timing of secondary bone grafting on the growth and development of dentofacial complex in patients with complete unilateral cleft lip and palate (UCLP).Design: Retrospective lateral cephalometric study.Interventions: Thirty patients received similar primary surgical procedures by the same surgeon and the similar first phase orthodontic treatment. These patients were divided into two groups according to their age at secondary bone grafting: 23 patients at a mean age of 9.6 years (early group) and 7 at a mean age of 12.2 years (late group).Methods: Lateral cephalometric radiographs of all subjects were obtained at two different times: at the age of 7 or 8 years (prior to bone grafting) and at the age of 15 or 16 years (more than one year after bone grafting). Twenty-eight measurement items on the sagittal and vertical growth of viscerocranium were compared between the early and late groups by the unpaired t-test.Results and discussion: Vertical maxillary growth was inhibited significantly in the early group in comparison with the late group; however, there was no significant difference in sagittal maxillary growth between the two groups. This suggests that sagittal anterior maxillary growth is almost completed before the age of 10 years, but the alveolar process is still growing vertically after the age of 10 years.
【目的】二次的顎裂部骨移植は,唇顎口蓋裂治療の一環として広く行われ,有効な方法である.しかし,骨移植が顎顔面の成長発育におよぼす影響については,いまだ意見の一致は得られていない.本研究の目的は,骨移植の手術時期の違いによる顎顔面の成長発育への影響を調査することである.【対象および方法】対象は当院で出生直後より管理している片側性完全唇顎口蓋裂患者のうち,1983年から1991年までの問に日本人両親から出生し,合併奇形のない30名(男性22名,女性8名)である.これらを顎裂部骨移植時の年齢が8歳から10歳(平均9.6歳)の早期群23名(男性18名,女性5名)と,11歳から13歳(平均12.2歳)の晩期群7名(男性4名,女性3名)に分類した.なお,両群問で口唇および口蓋閉鎖の時期と術式に違いはない.資料は,二次的顎裂部骨移植施行前の7～8歳時と,術後1年以上経過した15～16歳時に撮影した側面頭部エックス線規格写真を用いた.顎顔面の28項目について形態計測を行い,個・々の計測値と骨移植前後の計測値の変化量について両群問で比較検討した.なお,トレースを行う者と計測者を別とし,計測者には早期群か晩期群かの情報は与えなかった.【結果および考察】上顎骨の前後方向の変化量について両群問で有意差は認められなかった.一方,上顎骨前方部の垂直方向の変化量については,晩期群で有意に大きい値を示し,早期群で発育抑制がみられた.これは,上顎骨の前後方向への発育が10歳でほぼ終了するのに対し,垂直方向への発育はそれ以降も続くことによると考えられた. Objectives: The purpose of this study was to investigate the effects of the timing of secondary bone grafting on the growth and development of dentofacial complex in patients with complete unilateral cleft lip and palate (UCLP). Design: Retrospective lateral cephalometric study. Interventions: Thirty patients received similar primary surgical procedures by the same surgeon and the similar first phase orthodontic treatment. These patients were divided into two groups according to their age at secondary bone grafting: 23 patients at a mean age of 9.6 years (early group) and 7 at a mean age of 12.2 years (late group). Methods: Lateral cephalometric radiographs of all subjects were obtained at two different times: at the age of 7 or 8 years (prior to bone grafting) and at the age of 15 or 16 years (more than one year after bone grafting). Twenty-eight measurement items on the sagittal and vertical growth of viscerocranium were compared between the early and late groups by the unpaired t-test. Results and discussion: Vertical maxillary growth was inhibited significantly in the early group in comparison with the late group; however, there was no significant difference in sagittal maxillary growth between the two groups. This suggests that sagittal anterior maxillary growth is almost completed before the age of 10 years, but the alveolar process is still growing vertically after the age of 10 years. |
| Author | USUI, Yukiko ONO, Kazuhiro ASAHITO, Toshikazu KOCHI, Shoko TAKAGI, Ritsuo SAITO, Isao YAGI, Minoru |
| Author_FL | 高木 律男 碓井 由紀子 八木 稔 齋藤 功 幸地 省子 朝日藤 寿一 小野 和宏 |
| Author_FL_xml | – sequence: 1 fullname: 碓井 由紀子 – sequence: 2 fullname: 小野 和宏 – sequence: 3 fullname: 朝日藤 寿一 – sequence: 4 fullname: 幸地 省子 – sequence: 5 fullname: 高木 律男 – sequence: 6 fullname: 齋藤 功 – sequence: 7 fullname: 八木 稔 |
| Author_xml | – sequence: 1 fullname: KOCHI, Shoko organization: Clinics for Maxillo-Oral Disorders, Tohoku University Hospital – sequence: 1 fullname: TAKAGI, Ritsuo organization: Division of Oral and Maxillofacial Surgery, Department of Oral Health Science, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: SAITO, Isao organization: Division of Orthodontics, Department of Oral Biological Science, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: ONO, Kazuhiro organization: Division of Oral Hygiene and Health Promotion, Department of Oral Health and Welfare, Niigata University Faculty of Dentistry – sequence: 1 fullname: YAGI, Minoru organization: Division of Oral Hygiene and Health Promotion, Department of Oral Health and Welfare, Niigata University Faculty of Dentistry – sequence: 1 fullname: ASAHITO, Toshikazu organization: Division of Orthodontics, Department of Oral Biological Science, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences – sequence: 1 fullname: USUI, Yukiko organization: Division of Oral and Maxillofacial Surgery, Department of Oral Health Science, Course for Oral Life Science, Niigata University Graduate School of Medical and Dental Sciences |
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| References | 30)早津誠, 小野和宏, 飯田明彦, 他: Hotz床併用二段階口蓋形成手術法を施行した両側性唇顎口蓋裂児の顎発育に関する研究-5歳から12歳までの顎発育について-. 口科誌5216-16, 2003. 35) Slaughter, W. B., Pruzansky, S.: The rationale for velar closure as a primary procedure in the repair of cleft palate defects. Plast Reconstr Surg., 13 341-357, 1954. 29)小野和宏, 飯田明彦, 今井信行, 他: 二段階口蓋形成手術法を施行した片側性唇顎口蓋裂児の永久歯列弓形態-一段階法施行例および健常児との比較-. 日口蓋誌25: 36-44, 2000. 41) Sindet-Pederson, Enemark, H.: Comparative study of secondary and late secondary bonegrafting in patients with residual cleft defects. Short-term evaluation. Int J Oral Surg., 14 389-398, 1985. 3) Boyne, P. J., Sands, N. R.: Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg., 30: 87-92, 1972. 14) Bergland, 0., Semb, G., Å byholm, F. E.: Elimination of the residual alveolar cleft by secondary bone grafting and subsequent orthodontic treatment. Cleft Palate J., 23: 175-205, 1986. 34) Hayashi, I., Sakuda, M., Takimoto, K., et al.: Craniofacial growth in complete unilateral cleft lip and palate: A roentgeno-cephalometric study. Cleft Palate J., 13 215-237, 1975. 23)幸地省子, 東福寺直道, 松井桂子, 他: 顎裂への新鮮自家腸骨海綿骨細片移植-歯槽頂の高さの評価. 日口外誌, 39: 735-741, 1993. 32) Silvera, Q. A. E., Ishii, K., Arai, T., et al.: Longterm results of the two stage palatoplasty / Hotz'plate approach for complete bilateral cleft lip, alveolus and palate patients. J Craniomaxillofac Suru.. 31: 215-227. 2003. 12)幸地省子: 顎裂への新鮮自家腸骨海綿骨細片移植と上顎骨の成長. 日口蓋誌, 18: 10-17, 1993. 13) Leblet, L.: Growth changes of the palate. J Dent Res., 41: 1391-1404, 1962. 16)飯田明彦, 大橋 靖, 高木律男, 他: 二段階法における硬口蓋閉鎖法の検討. 日口蓋誌23: 68-74, 1998. 28)福原信玄, 大橋 靖: 片側性唇顎口蓋裂児の新生児から7歳までの顎発育に関する研究-Hotz床2段階手術例と健常児の比較-. 口科誌43: 227-239, 1996. 11) Chang, H-P., Chuang M-C., Yang, Y-H., et al.: Maxillofacial growth in children with unilateral cleft lip and palate following secondary alveolar bone grafting: An interim evaluation. Plast Reconstr Surg., 115: 687-695, 2005. 18)碓井由紀子, 小野和宏, 高木律男, 他: 顎裂部への二次的骨移植に関する臨床統計的観察. 新潟歯学会雑誌32: 53-61, 2002. 5) Ross, R. B.: Treatment variables affecting facial growth in complete unilateral cleft lip and palate. Part 3; Alveolus repair and bone grafting. Cleft Palate J., 24: 33-44, 1987. 24)大橋 靖: 口蓋形成手術と顎発育-ヨーロッパにおける口蓋裂治療の現況-. 新潟歯学会雑誌14: 1-12, 1984. 6) Enemark, H., Sinded-Pedersen, S., Bundgaard, M.: Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac surg., 45: 913-918, 1987. 22)幸地省子, 松井桂子, 飯野光喜, 他: 顎裂への新鮮自家腸骨海綿骨細片移植-垂直的な骨架橋幅の評価-. 日口外誌39: 972-983, 1993. 4) Kortebein, M. J., Nelson, C. L., Sadove, A. M.: Retrospective analysis of 135 secondary alveolar cleft grafts using iliac or calvarial bone. J Oral Maxillofac Surg., 49: 493-498, 1991. 21)飯塚哲夫, 石川富士郎: 頭部X線規格写真法における計測点の設定について. 日矯歯誌, 16: 66-75, 1957. 9) Daskalogiannakis, J., Ross, R. B.: Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J., 34: 454-458, 1997. 36) Owman-Moll, P., Katsaros, C., Friede, H.: Development of the Residual Cleft in the Hard Palate after Velar Repair in a 2-Stage Palatal Repair Regimen. J Orofac Orthop/Fortschr Kieferorthop., 59 286-300, 1998. 20) Downs, W. B.: Variations in facial relationships, their significance in treatment and prognosis. Amer J Orthod, 34: 812-840, 1948. 27)神成庸二, 大橋 靖: 両側性唇顎口蓋裂児の顎発育に関する研究-Hotz床併用二段階口蓋形成手術例について-. 口科誌, 43: 423-439, 1994. 17)越後成志, 猪狩俊郎, 下田元, 他: 顎裂部に対する自家腸骨海綿骨細片移植-第1報手術手技について. 日口外誌32: 1442-1446, 1986. 19)作田 守: 口蓋裂の基礎と臨床顔面の成長を中心に-. 日矯歯誌, 37: 139-160, 1978. 8) Semb, G.: Effect of alveolar bone grafting on maxillary growth in unilateral cleft lip and palate patients. Cleft Palate J., 25: 288-295, 1988. 37)日本小児歯科学会: 日本人小児における乳歯・永久歯の萌出時期に関する調査研究. 日児歯誌26: 1-18, 1988. 40) Å byholm, F. E., Bergland, 0., Semb, G.: Secondary bone grafting of alveolar clefts A surgical/ orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Reconstr Surg., 15: 127-140, 1981. 39) Ochoa, B. K., Nanda, R. S.: Comparison of maxillary and mandibular growth. Amer J Orthod Dentofac Orthoped., 125: 148-159, 2004. 2) Boyne, P. J., Sands, N. R.: Combined orthodonticsurgical management of residual palato-alveolar cleft defects. Amer J Orthod., 70: 20-37, 1976. 38)浅井保彦: 日本人顎・顔面頭蓋の成長-頭部X線規格写真法による12歳から20歳までの縦断的研究-. 日矯歯誌, 32: 61-98, 1973. 25)小野和宏, 石井一裕: 新潟大学歯学部附属病院における唇顎口蓋裂患者の管理・治療について. 矯正臨床, 23: 1-17, 2001. 42)北村信隆, 内山健志, 渡辺一, 他: 各種移植骨による2次顎裂部骨移植術術後の遠隔成績-1975年から1988年の症例について-. 日口蓋誌23: 13-27, 1998. 33)高木律男, 福田純一, 小野和宏, 他: Hotz床併用二段階口蓋形成法の長期予後-片側症例の成長終了時側面頭部エックス線規格写真による評価-. 日口蓋誌31: 245-252, 2006. 26)中野 久, 大橋 靖, 高桑きよみ, 他: 唇顎口蓋裂患児の顎発育に関する研究Hotz plate装着・2段階手術施行症例における顎発育について. 唇顎口蓋裂患児の顎発育に関する研究. 哺乳床・2段階手術を含む各種治療法の比較. 昭和62年・63年度科学研究費補助金(総合研究A)研究結果報告書: 13-25, 1989. 31) Arai, T., Ishii, K., Morita, S., et al.: Effects of Hotz' plate-based two-stage palatoplasty on craniofacial development. J Jpn Cleft Palate Assoc., 27: 306-324, 2002. 1)高橋庄二郎: 片側口唇裂の手術高橋庄二郎著; 口唇裂・口蓋裂の基礎と臨床. 277-281, 321-323, 1996. 7) Brattström, V., McWilliam, J., Larson, O., et al.: Craniofacial Development in Children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. Scand J Plast Reconstr Hand Surg., 25: 259- 267, 1991. 10) Levitt, T., Long, R. E., Trotman, C. A.: Maxillary growth in patients with clefts following secondary alveolar bone grafting. Cleft Palate Craniofac J., 36: 398-406, 1999. 15) Perko, M. A.: Two-stage closure of cleft palate (Progress report). J Maxillofac Surg., 7: 76-80, 1979. |
| References_xml | – reference: 7) Brattström, V., McWilliam, J., Larson, O., et al.: Craniofacial Development in Children with unilateral clefts of the lip, alveolus, and palate treated according to four different regimes. Scand J Plast Reconstr Hand Surg., 25: 259- 267, 1991. – reference: 26)中野 久, 大橋 靖, 高桑きよみ, 他: 唇顎口蓋裂患児の顎発育に関する研究Hotz plate装着・2段階手術施行症例における顎発育について. 唇顎口蓋裂患児の顎発育に関する研究. 哺乳床・2段階手術を含む各種治療法の比較. 昭和62年・63年度科学研究費補助金(総合研究A)研究結果報告書: 13-25, 1989. – reference: 38)浅井保彦: 日本人顎・顔面頭蓋の成長-頭部X線規格写真法による12歳から20歳までの縦断的研究-. 日矯歯誌, 32: 61-98, 1973. – reference: 3) Boyne, P. J., Sands, N. R.: Secondary bone grafting of residual alveolar and palatal clefts. J Oral Surg., 30: 87-92, 1972. – reference: 17)越後成志, 猪狩俊郎, 下田元, 他: 顎裂部に対する自家腸骨海綿骨細片移植-第1報手術手技について. 日口外誌32: 1442-1446, 1986. – reference: 6) Enemark, H., Sinded-Pedersen, S., Bundgaard, M.: Long-term results after secondary bone grafting of alveolar clefts. J Oral Maxillofac surg., 45: 913-918, 1987. – reference: 1)高橋庄二郎: 片側口唇裂の手術高橋庄二郎著; 口唇裂・口蓋裂の基礎と臨床. 277-281, 321-323, 1996. – reference: 10) Levitt, T., Long, R. E., Trotman, C. A.: Maxillary growth in patients with clefts following secondary alveolar bone grafting. Cleft Palate Craniofac J., 36: 398-406, 1999. – reference: 25)小野和宏, 石井一裕: 新潟大学歯学部附属病院における唇顎口蓋裂患者の管理・治療について. 矯正臨床, 23: 1-17, 2001. – reference: 40) Å byholm, F. E., Bergland, 0., Semb, G.: Secondary bone grafting of alveolar clefts A surgical/ orthodontic treatment enabling a non-prosthodontic rehabilitation in cleft lip and palate patients. Scand J Plast Reconstr Surg., 15: 127-140, 1981. – reference: 9) Daskalogiannakis, J., Ross, R. B.: Effect of alveolar bone grafting in the mixed dentition on maxillary growth in complete unilateral cleft lip and palate patients. Cleft Palate Craniofac J., 34: 454-458, 1997. – reference: 13) Leblet, L.: Growth changes of the palate. J Dent Res., 41: 1391-1404, 1962. – reference: 41) Sindet-Pederson, Enemark, H.: Comparative study of secondary and late secondary bonegrafting in patients with residual cleft defects. Short-term evaluation. Int J Oral Surg., 14 389-398, 1985. – reference: 15) Perko, M. A.: Two-stage closure of cleft palate (Progress report). J Maxillofac Surg., 7: 76-80, 1979. – reference: 24)大橋 靖: 口蓋形成手術と顎発育-ヨーロッパにおける口蓋裂治療の現況-. 新潟歯学会雑誌14: 1-12, 1984. – reference: 12)幸地省子: 顎裂への新鮮自家腸骨海綿骨細片移植と上顎骨の成長. 日口蓋誌, 18: 10-17, 1993. – reference: 18)碓井由紀子, 小野和宏, 高木律男, 他: 顎裂部への二次的骨移植に関する臨床統計的観察. 新潟歯学会雑誌32: 53-61, 2002. – reference: 31) Arai, T., Ishii, K., Morita, S., et al.: Effects of Hotz' plate-based two-stage palatoplasty on craniofacial development. J Jpn Cleft Palate Assoc., 27: 306-324, 2002. – reference: 33)高木律男, 福田純一, 小野和宏, 他: Hotz床併用二段階口蓋形成法の長期予後-片側症例の成長終了時側面頭部エックス線規格写真による評価-. 日口蓋誌31: 245-252, 2006. – reference: 4) Kortebein, M. J., Nelson, C. L., Sadove, A. 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| SubjectTerms | craniofacial growth lateral cephalometric radiographs secondary alveolar bone grafting unilateral cleft lip and palate 二次的顎裂部骨移植 側面頭部エックス線規格写真 片側性完全唇顎口蓋裂 顎顔面発育 |
| Title | Effects of Secondary Bone Grafting Period on Growth and Development in Dentofacial Complex in Patients with Complete Unilateral Cleft Lip and Palate |
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